Background: Before doing percutaneous tracheostomy (PCT), studies have shown that mapping the neck region with ultrasound (US) is beneficial. Objective: This study aimed to check the effectiveness of ultrasound guided percutaneous tracheostomy for patients in critical condition. Patients and Methods: 24 mechanically ventilated patients at the Otorhinolaryngology Department and the Anesthesia and Intensive Care Unit of Zagazig University Hospital who were indicted for elective ultrasonography guided percutaneous tracheostomy in the period from June 2021 to December 2021. Results: The mean incision length was less than 2 cm and the duration of procedure was 22.08 minutes while the average duration of intubation was 13.25 days.75% of patients had excellent, 12.5% of patients were good, and 12.5% were unsatisfactory, for ease of ultrasonic visualization. Conclusion: Using ultrasound to guide the percutaneous tracheostomy operation could be an effective and less invasive technique.